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获得性免疫缺陷综合征患者的脑弓形虫病

[Cerebral toxoplasmosis in subjects with acquired immunodeficiency syndrome].

作者信息

Orefice G, Carrieri P B, Chirianni A, Tullio-Cataldo P, Farace A, Gentile S, Troisi E, Striano S

机构信息

Istituto per lo Studio delle Malattie del Sistema Nervoso, 2a Facoltà di Medicina e Chirurgia, Napoli.

出版信息

Riv Neurol. 1989 May-Jun;59(3):89-93.

PMID:2595210
Abstract

Cerebral toxoplasmosis is the most common cause of focal CNS disease complicating AIDS and may afflict 10% to 33% of such patients. We present the clinical, neuroradiological and immunological findings in 5 cases with cerebral toxoplasmosis complicating the acquired immune deficiency syndrome. All patients had focal neurological signs and symptoms; CT scan findings included single or multiple lesions with ring contrast enhancement, mass effect and oedema. CSF analysis showed increased protein levels, decreased glucose levels and pleocytosis; CSF IgG antitoxoplasma antibodies were positive in 4 patients; serum IgG antitoxoplasma antibodies were positive in all patients, while IgM resulted always negative in serum and in CSF. After therapy, in 2 cases CT scans showed small areas of encephalomalacia replacing the abscesses. We think that non-invasive techniques (CT scans, CSF and serum immunochemical tests) together with the finding of a favourable response to therapy may be useful for the diagnosis of cerebral toxoplasmosis, allowing to avoid invasive technique such as cerebral biopsy.

摘要

脑弓形虫病是艾滋病患者并发中枢神经系统局灶性疾病最常见的病因,可能累及10%至33%的此类患者。我们报告了5例艾滋病合并脑弓形虫病患者的临床、神经放射学和免疫学表现。所有患者均有局灶性神经体征和症状;CT扫描结果包括单个或多个有环形强化、占位效应和水肿的病变。脑脊液分析显示蛋白水平升高、葡萄糖水平降低和细胞增多;4例患者脑脊液IgG抗弓形虫抗体呈阳性;所有患者血清IgG抗弓形虫抗体均呈阳性,而血清和脑脊液中的IgM始终为阴性。治疗后,2例患者的CT扫描显示小面积脑软化取代了脓肿。我们认为,非侵入性技术(CT扫描、脑脊液和血清免疫化学检测)以及对治疗有良好反应的发现可能有助于脑弓形虫病的诊断,从而避免采用脑活检等侵入性技术。

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